We are seeking a CO Collection Specialist. The Co Collection Specialist will be responsible for the basic collection of unpaid third-party claims and standard appeals, using various JHM applications and JHU/ PBS billing applications. They will communicate with payers to resolve issues and facilitate prompt payment of claims. They will follow-up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process, either electronically or by paper. This position will recognize and resolve incorrect demographic and insurance registration based on an understanding of the outpatient registration process. The Specialist will use an understanding of claims submission requirements for payors in order to expedite payments and possess a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior specialist.
Specific Duties & Responsibilities
Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Review and update patient registration information (demographic and insurance) as needed.
Applies appropriate discounts / courtesies based on department policy.
Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
Prints and mails claim forms and statements according to the follow-up matrix.
Retrieves supporting documents (medical reports, authorizations, etc) as needed and submits to third-party payers.
Appeals reflected claims and claims with low reimbursement.
Performs claim edits as needed.
Confirm credit balances and gathers necessary documentation for processing refund.
Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
Contacts the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
Monitor invoice activity until problem is resolved.
Process daily mail, edits reports, file or pull EOB batches.
Identifies and escalates non-standard appeals to a higher-level specialist.
Informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
Familiarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of medical billing applications.
Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development
Participate in on-going educational activities.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
High School Diploma or graduation equivalent.
One year experience in a medical billing or similar specialty environment required.
Knowledge of medical terminology, CPT/ICD codes and diagnosis coding required.
Ability to use various billing and patient information computer systems preferred.
Knowledge of various payer processing and submission guidelines preferred.
Classified Title: Collection Specialist Working Title: CO Collection Specialist Role/Level/Range: ATO 37.5/02/OC Starting Hourly Pay Rate Range: Min $15.50 - Max $25.00 HRLY ($24.04/hr. Budgeted; Commensurate with experience) Employee group: Full Time Schedule: M-F, 8:00am-4:00pm Exempt Status: Non-Exempt Location: Hybrid Department name: 10003152-SOM Rad Onc Clinical Faculty and Staff Personnel area: School of Medicine
Total Rewards The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
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